Stress management interventions for HIV+ adults: A meta-analysis of randomized controlled trials, 1989 to 2006.

Abstract

Objective: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults.Design-This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress-management interventions for HIV+ adults (N = 3,077).Main Outcome Measures-Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue).Results-Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d + s = 0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls.Conclusion-Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week post-intervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and Caucasian participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration. Coping with a chronic, life-threatening disease, however, is not without consequence as disease progression often involves a series of psychological and physical stressors that may impair daily functioning and quality of life. These stressors may involve a variety of physical symptoms, pain, concerns over disclosure of and stigma associated with HIV, and distress regarding one's own mortality (Derlega, Winstead, Greene, Serovich, & Elwood, 2002;Kalichman & Catz, 2000). NIH Public AccessResearch has demonstrated that such psychological and physical stressors can alter physiological processes and undermine health (see Kemeny, 2003;McEwen, 1998;Tosevski & Milovancevic, 2006;Vanable, Carey, Blair, & Littlewood, 2006). Although acute activation of these physiological processes is adaptive, chronic activation may lead to negative health effects including impaired immune functioning (see Segerstrom and Miller, 2004). Indeed, increased stress associated with chronic medical diseases such as HIV/AIDS appears to accelerate immune impairment, including reduced lymphocyte circulation and increased cortisol levels and a m...

Effects of a cognitive behavioral self-help program and a computerized structured writing intervention on depressed mood for HIV-infected people: A pilot randomized controlled trial

“…Overall, psychological interventions for HIV-infected persons significantly improve mental health and quality of life [8][9][10][11]. There is limited evidence suggesting intervention effects on CD4+ counts and viral load [10][11][12].…”

“…Several review studies have been performed, showing that all programs involved group-based or individualized face to face contact, and consisted of multiple sessions [8][9][10][11][12]. Overall, psychological interventions for HIV-infected persons significantly improve mental health and quality of life [8][9][10][11]. There is limited evidence suggesting intervention effects on CD4+ counts and viral load [10][11][12].…”

“…The majority of these interventions employ cognitive-behavioral intervention (CBI) techniques (see review studies: [8][9][10][11][12]). Several review studies have been performed, showing that all programs involved group-based or individualized face to face contact, and consisted of multiple sessions [8][9][10][11][12]. Overall, psychological interventions for HIV-infected persons significantly improve mental health and quality of life [8][9][10][11].…”

Optimizing the effects of stress management interventions in HIV.

“…The results of the meta-analysis presented by Scott-Sheldon et al, (2008) raise some issues concerning assessment and analysis that may affect the ability to demonstrate the efficacy of stress management interventions. First, the authors report that the treatment effects for anxiety were heterogeneous and that this heterogeneity may be accounted for by the incorporation of adherence training components.…”

“…This may contribute to floor effects and may restrict the ability of randomized controlled trials of cognitive-behavioral stress management to achieve larger effect sizes. In fact, moderation analysis conducted by Scott-Sheldon et al, (2008) identified larger treatment effects for anxiety among those who were more anxious at baseline, suggesting greater treatment effects are associated with higher levels of baseline distress.…”